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Giordano M, Marzullo R, Gaio G, Bigazzi MC, Palladino MT, Della Cioppa N, Gaudieri G, Fabiani D, Sarubbi B, Russo MG. Assessing the feasibility of using the antecubital vein to perform right heart catheterization in children and adults with congenital heart disease: a retrospective, observational single-center study. J Invasive Cardiol 2023; 35. [PMID: 37984324 DOI: 10.25270/jic/23.00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Right heart catheterization (RHC) usually is performed via the femoral vein or the internal jugular vein. However, the antecubital fossa vein is a valid venous access, and it has become increasingly popular to perform right heart catheterization utilizing this access. METHODS A retrospective, observational study was conducted to describe use of the antecubital fossa vein for right heart catheterization in adults and children with congenital heart disease (CHD). Patients who had undergone RHC via antecubital fossa vein at the authors' hospital between September 2019 and December 2022 were included. The outcomes studied were procedural failure and procedure-related adverse events. RESULTS Fifty-two patients with CHD underwent right cardiac catheterization via an upper arm vein. The upper arm vein was unable to perform the RHC in only 2 patients (3.8%). Only 1 patient developed a minor adverse event. No irreversible and/or life-threating adverse events were detected. CONCLUSIONS The upper arm veins are safe and effective to perform a RHC in children and adults with CHD. This approach demonstrates a high percentage of technical success, and few mild complications.
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Affiliation(s)
- Mario Giordano
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy.
| | - Raffaella Marzullo
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Gianpiero Gaio
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Invasive Cardiology Unit, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maria Teresa Palladino
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Nadia Della Cioppa
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Gabriella Gaudieri
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Dario Fabiani
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
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Pewowaruk R, Hermsen J, Johnson C, Erdmann A, Pettit K, Aesif S, Ralphe JC, Francois CJ, Roldán-Alzate A, Lamers L. Pulmonary artery and lung parenchymal growth following early versus delayed stent interventions in a swine pulmonary artery stenosis model. Catheter Cardiovasc Interv 2020; 96:1454-1464. [PMID: 33063918 PMCID: PMC10831906 DOI: 10.1002/ccd.29326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Compare lung parenchymal and pulmonary artery (PA) growth and hemodynamics following early and delayed PA stent interventions for treatment of unilateral branch PA stenosis (PAS) in swine. BACKGROUND How the pulmonary circulation remodels in response to different durations of hypoperfusion and how much growth and function can be recovered with catheter directed interventions at differing time periods of lung development is not understood. METHODS A total of 18 swine were assigned to four groups: Sham (n = 4), untreated left PAS (LPAS) (n = 4), early intervention (EI) (n = 5), and delayed intervention (DI) (n = 5). EI had left pulmonary artery (LPA) stenting at 5 weeks (6 kg) with redilation at 10 weeks. DI had stenting at 10 weeks. All underwent right heart catheterization, computed tomography, magnetic resonance imaging, and histology at 20 weeks (55 kg). RESULTS EI decreased the extent of histologic changes in the left lung as DI had marked alveolar septal and bronchovascular abnormalities (p = .05 and p < .05 vs. sham) that were less prevalent in EI. EI also increased left lung volumes and alveolar counts compared to DI. EI and DI equally restored LPA pulsatility, R heart pressures, and distal LPA growth. EI and DI improved, but did not normalize LPA stenosis diameter (LPA/DAo ratio: Sham 1.27 ± 0.11 mm/mm, DI 0.88 ± 0.10 mm/mm, EI 1.01 ± 0.09 mm/mm) and pulmonary blood flow distributions (LPA-flow%: Sham 52 ± 5%, LPAS 7 ± 2%, DI 44 ± 3%, EI 40 ± 2%). CONCLUSION In this surgically created PAS model, EI was associated with improved lung parenchymal development compared to DI. Longer durations of L lung hypoperfusion did not detrimentally affect PA growth and R heart hemodynamics. Functional and anatomical discrepancies persist despite successful stent interventions that warrant additional investigation.
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Affiliation(s)
- Ryan Pewowaruk
- Biomedical Engineering, University of Wisconsin – Madison
| | - Joshua Hermsen
- School of Medicine and Public Health, University of Wisconsin – Madison
- Cardiovascular Surgery, University of Wisconsin – Madison
| | | | - Alexandra Erdmann
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Kevin Pettit
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Scott Aesif
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pathology, University of Wisconsin – Madison
| | - J. Carter Ralphe
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
| | - Christopher J. Francois
- School of Medicine and Public Health, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin – Madison
- Mechanical Engineering, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Luke Lamers
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
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Lawson EN, Seckeler MD. Successful Percutaneous Recanalization of a Chronically Occluded Inferior Vena Cava in a Young Child. World J Pediatr Congenit Heart Surg 2018; 11:NP186-NP189. [PMID: 30296929 DOI: 10.1177/2150135118771316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young children with congenital heart disease are undergoing an increasing number of catheter-based interventions. These procedures can lead to obstruction of large central veins, making future interventions more challenging or even impossible. We present a young child with a chronically occluded inferior vena cava (IVC) secondary to prior catheterization-based interventions for congenital heart disease. The IVC was recanalized with serial angioplasty and stent placement with continued patency for over two years. Despite the long duration of obstruction, the IVC was successfully recanalized, eliminating the potential consequences of long-term IVC obstruction and making it easier for future catheter-based interventions, if needed.
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Affiliation(s)
- Emily N Lawson
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
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Srivastava NT, Hoyer MH. Thromboexclusion of an atypical left ventricular pseudoaneurysm. Catheter Cardiovasc Interv 2015; 85:274-7. [PMID: 24824727 DOI: 10.1002/ccd.25547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 04/29/2014] [Accepted: 05/11/2014] [Indexed: 11/12/2022]
Abstract
Left ventricular pseudoaneurysm is rare in children. The gold standard for treatment has been surgical repair. Here, we describe a boy in whom an atypical left ventricular pseudoaneurysm was treated through staged transcatheter procedures. In addition, we highlight the importance of the preprocedure cardiac magnetic resonance imaging in providing invaluable information that allowed detailed planning of a management strategy for this unusual pseudoaneurysm.
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Affiliation(s)
- Nayan T Srivastava
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Darby S, Ilbawi M, Amin Z. Perventricular closure of pulmonary stump in a 16-kg child. Catheter Cardiovasc Interv 2015; 85:271-3. [PMID: 24677797 DOI: 10.1002/ccd.25497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/14/2014] [Accepted: 03/23/2014] [Indexed: 11/06/2022]
Abstract
Blind pouch formation of the pulmonary artery (PA) in patients having undergone a Fontan operation can present a serious risk for thromboembolic events. Either primary or secondary closure of this stump is necessary to reduce this risk. Unfortunately, secondary closure is oftentimes difficult due to the size and anatomy of the presenting patient. We describe the insertion of a muscular ventricular septal defect (VSD) device via a perventricular approach for successful closure of a pulmonary stump in a 3-year old, 16-kg child. To our knowledge, this is the first report of a perventricular approach for successful closure of a PA stump.
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Affiliation(s)
- Scott Darby
- Department of Pediatrics, Georgia Regents University, Children's Medical Center, Augusta, Georgia
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Gössl M, Johnson JN, Hagler DJ. Failing left ventricle to ascending aorta conduit-Hybrid implantation of a melody valve and NuMed covered stent. Catheter Cardiovasc Interv 2014; 83:778-81. [PMID: 23784974 DOI: 10.1002/ccd.25075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/09/2013] [Indexed: 11/10/2022]
Abstract
We present the case of a 36-year-old woman with increasing shortness of breath, a new 3/4 diastolic murmur, and a complex history of LV outflow tract obstruction. She has undergone multiple surgeries including the replacement of her old LV apex to ascending aorta conduit with a 20-mm Gore-Tex tube graft, addition of a 24-mm homograft sutured between the conduit and the LV apex, and insertion of a 21-mm Freestyle porcine valve conduit between the Gore-Tex tube graft and allograft at age 23. The current assessment showed a failing Freestyle conduit prosthesis leading to left heart decompensation. Due to substantial surgical risk, the patient underwent successful implantation of a Melody valve into the Gore-Tex tube and exclusion of the failing Freestyle bioprosthesis with a NuMed CP stent in a hybrid procedure. The case nicely illustrates the collaborative potential of cardiovascular surgeons and interventional cardiologists in the new arena of a hybrid operating room. Complex hybrid procedures like the current one, especially those including percutaneous placements of valves, offer therapeutic options for patients that are otherwise too high risk for conventional open heart surgery.
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Affiliation(s)
- Mario Gössl
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
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Abu Hazeem AA, Dori Y, Whitehead KK, Harris MA, Fogel MA, Gillespie MJ, Rome JJ, Glatz AC. X-ray magnetic resonance fusion modality may reduce radiation exposure and contrast dose in diagnostic cardiac catheterization of congenital heart disease. Catheter Cardiovasc Interv 2014; 84:795-800. [PMID: 24619541 DOI: 10.1002/ccd.25473] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/25/2014] [Accepted: 03/01/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Radiation exposure in the pediatric population may increase the risk of future malignancy. Children with congenital heart disease who often undergo repeated catheterizations are at risk. One possible strategy to reduce radiation is to use X-ray Magnetic Resonance Fusion (XMRF) to facilitate cardiac catheterization. METHODS Catheterization data of patients who underwent diagnostic XMRF procedures between January 1, 2009 and February 1, 2012 were reviewed. Cases were matched 1:1 to contemporary controls who did not undergo XMRF based on weight and diagnosis and were compared in radiation exposure, contrast dose, and procedural and anesthesia times. RESULTS Forty-four matched pairs were included. Baseline demographics were similar in both groups. Patients in the XMRF group had lower indices of radiation exposure measured by fluoroscopy time (14 vs. 16.4 vs. P = 0.047), dose-area product from fluoroscopy (513.2 vs. 589.1 µGy·m(2) , P = 0.042), total dose-area product (625.8 vs. 995.2 µGy·m(2) , P = 0.027), and total air kerma dose (94.5 vs. 153.8 mGy, P = 0.017). There was also a significant reduction in contrast dose (2 vs. 3.3 cc/kg, P <0.001). Procedural time tended to be shorter in the XMRF group but anesthesia time was significantly longer. CONCLUSION Select diagnostic cardiac catheterization cases that utilized XMRF used less radiation and contrast than similar cases where XMRF was not used. Future work is needed to determine whether similar benefits can be extended to other types of diagnostic and complex interventional procedures.
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Affiliation(s)
- Anas A Abu Hazeem
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Hovis IW, Sutton NJ, Pass RH. Intervening for RPA stenosis following Waterston shunt: Importance of anatomical definition of the coronary arteries. Catheter Cardiovasc Interv 2014; 83:591-4. [PMID: 24243825 DOI: 10.1002/ccd.25003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 02/25/2013] [Accepted: 05/12/2013] [Indexed: 11/07/2022]
Abstract
Right pulmonary artery (RPA) stenosis following Waterston shunt is common. We report a case of RPA stenosis many years following tetralogy of Fallot repair with take-down of a Waterston shunt and demonstrate an unusual and important anatomic variant of proximity of the left coronary artery to the mid-portion of the RPA.
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Affiliation(s)
- Ian W Hovis
- Pediatric Interventional Cardiology, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Rohit MK, Gupta A. Transcatheter closure of large patent ductus arteriosus using custom made devices. Catheter Cardiovasc Interv 2014; 89:E194-E199. [PMID: 24323820 DOI: 10.1002/ccd.25349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/12/2013] [Accepted: 11/27/2013] [Indexed: 11/09/2022]
Abstract
There has been a paradigm shift in the transcatheter closure of patent ductus arteriosus (PDA) over the last 45 years. With the availability of various coils, plugs and occluders, PDA of almost all shapes and sizes are amenable to transcatheter closure. However, very large PDA diagnosed late in life are being referred for surgical closure in the absence of availability of large size devices, especially in developing countries. In this case series, we have described four patients with large PDA, three of which were closed by transcatheter custom made PDA occluders. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Ankur Gupta
- Department of Cardiology, PGIMER, Chandigarh, India
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10
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Patange A, Blake J, Gowda S. Complete Blalock-Taussig shunt obstruction in < 24 hours post-operative period in a neonate treated emergently using transcatheter angioplasty and low dose local recombinant TPA. Catheter Cardiovasc Interv 2013; 83:964-7. [PMID: 24867628 DOI: 10.1002/ccd.25281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/16/2013] [Accepted: 10/28/2013] [Indexed: 11/05/2022]
Abstract
A 12-day-old infant with pulmonary atresia, intact ventricular septum, and pulmonary blood flow through a ductus arteriosus developed complete shunt obstruction within 12 hr of creation of a modified Blalock-Taussig shunt. Low dose recombinant tissue plasminogen activator was administered locally as two 0.03 mg/kg bolus injections and was followed by balloon angioplasty. This resulted in complete recanalization of the shunt without any hemorrhagic complications.
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Affiliation(s)
- Amit Patange
- Carman and Ann Adams Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, Michigan
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Zhou K, Hua Y, Qiao L. A case of late-onset sustained ventricular tachycardia following deployment of Amplatzer-type perimembranous VSD occluder. Catheter Cardiovasc Interv 2013; 83:256-60. [PMID: 22927019 DOI: 10.1002/ccd.24627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 08/20/2012] [Indexed: 11/09/2022]
Abstract
Transcatheter closure of ventricular septal defect (VSD) has been widely used worldwide. Despite high success rate and minimal operative mortality, arrhythmia during and post-operation has been frequently observed. However, sustained ventricular tachycardia following deployment of occluder has not been reported. In this present case, we present one rare case of late-onset sustained ventricular tachycardia, which developed 71 hr after deployment of an Amplatzer-type occluder for perimembranous VSD (PmVSD) in a 3-year and 5-month-old boy. The sustained ventricular tachycardia was successfully corrected with the administration of lidocaine, amiodarone, and dexamethasone. The reoccurrence of ventricular tachycardia was not observed in the most recent follow-up at 6 month. In summary, the current case indicated that sustained ventricular tachycardia could occur following deployment of Amplatzer-type occluder for PmVSD, which could be corrected with antiarrhythmic drugs.
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Affiliation(s)
- Kaiyu Zhou
- Department of Pediatric Cardiology, Sichuan University, Chengdu, 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China; Yangtze River Scholars Program and Innovative Research Team in University, West China Second University Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, China
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Turner ME, Lai WW, Vincent JA. Percutaneous closure of tricuspid paravalvular leak. Catheter Cardiovasc Interv 2013; 82:E511-5. [PMID: 23554068 DOI: 10.1002/ccd.24808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 12/04/2012] [Accepted: 01/01/2013] [Indexed: 11/10/2022]
Abstract
While transcatheter closure of mitral and aortic paravalvular leaks has been well-described, there are no prior reports of such procedures for prosthetic tricuspid valves. We describe our experience with percutaneous closure of a tricuspid paravalvular leak in a 34-year-old patient with a history of tricuspid atresia. He had previously undergone repair with placement of a right atrium-to-right ventricle conduit and most recently, placement of a bio-prosthetic tricuspid valve. He subsequently developed significant tricuspid paravalvular leak with symptoms of severe right heart failure. His clinical status was improved following successful transcatheter closure of the defect.
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Affiliation(s)
- Mariel E Turner
- Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York
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Amin Z. Echocardiographic predictors of cardiac erosion after Amplatzer septal occluder placement. Catheter Cardiovasc Interv 2013; 83:84-92. [PMID: 24038861 DOI: 10.1002/ccd.25175] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 11/06/2022]
Abstract
UNLABELLED The risk of erosion after Amplatzer septal occluder (ASO) device placement in atrial septal defects is well described. Aortic rim deficiency and use of over-sized device increase the risk of erosion. This study attempts to describe device characteristics, anatomical features and echocardiographic predictors that increase the risk of erosion. METHODS From 2005 through 2012, 12 new cases, with nine confirmed and three suspected device erosions where pre-procedural, intra-procedural, and/or post-procedural echocardiograms were available and, were reviewed. Following parameters were evaluated: ASD location (high or low), rims deficiency and consistency, septal mal-alignment, dynamic nature of the defect; device edge relationship toward the transverse sinus (TS), atrial free wall tenting and the size of the defect compared with the size of the device used for closure. RESULTS We found poor posterior rim consistency, aortic rim absence (in multiple views) and absent aortic rim at O degree in 100% of the patients. Septal mal-alignment and dynamic ASD was present in nearly 50% of the cases. The device was over-sized in three patients only. A 26-mm device was the most common device that resulted in erosion. In cases, where patient had experienced bloody pericardial effusion and the device was in place, device tenting in the TS was observed. Surgical explantation of the device confirmed presence of erosion in all cases. CONCLUSION Aortic rim absence in multiple views, poor posterior rim consistency, septal mal-alignment, and dynamic ASD appear to be factors where erosion risk increases significantly. A thorough assessment of the device edge by echocardiography in short-axis may show device tenting of the atrial free wall into the TS. This finding should be a strong indictor to recommend surgical removal of device after occurrence of pericardial effusion.
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Affiliation(s)
- Zahid Amin
- Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
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Lee SM, Song JY, Choi JY, Lee SY, Paik JS, Chang SI, Shim WS, Kim SH. Transcatheter closure of perimembranous ventricular septal defect using Amplatzer ductal occluder. Catheter Cardiovasc Interv 2013; 82:1141-6. [PMID: 23554093 DOI: 10.1002/ccd.24810] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/02/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To show that transcatheter closure of perimembranous ventricular septal defect (PMVSD) with the Amplatzer ductal occluder (ADO, AGA Medical Corp, Plymouth, Minnesota) is a safe and effective treatment option. BACKGROUND Transcatheter closure of PMVSD is a challenging procedure. Recently, the Amplatzer PMVSD occluder (APMVSDO, AGA Medical Corp, Plymouth, Minnesota) has been shown to be effective in closing hemodynamically significant PMVSDs. However, the high incidence of complete atrioventricular block (CAVB) after device occlusion of a PMVSD has been a hot issue as well. METHODS Among several devices used in closing PMVSD percutaneously, we prefer the ADO because of the anatomic resemblance between PMVSD with aneurysm and patent ductus arteriosus, and it has no right ventricular disc which may contribute to the occurrence of CAVB. RESULTS Between August 2009 and May 2012, 21 patients (5 males and 16 females) underwent percutaneous PMVSD closure using ADO. The patients' ages ranged from 3 to 42 years (median: 7 years), and their weights ranged from 18 kg to 60 kg (median: 27 kg). All patients showed echocardiographic signs of left ventricular volume overload and trivial to small mitral regurgitation (Qp/Qs = 1.7 ± 0.4). The mean defect size of the right ventricular side was 4.3 ± 1.0 mm. Devices 2 mm larger than the measured narrowest VSD diameter were selected in most patients. The ADOs were successfully implanted in all patients without any significant complications except one transient CAVB, one case of delivery wire fracture, and one case of surgery due to significant residual leak. Small residual shunts were observed immediately after the device implantation, but they disappeared during follow-up for 18 of 20 patients. The mean follow-up period was 20 ± 9 months, and CAVB or aortic regurgitation was not observed in all patients. CONCLUSION Transcatheter closure of PMVSD with the ADO is a safe and promising treatment option, but long-term follow-up in a large number of patients would be warranted.
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Affiliation(s)
- Sang Mi Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sinisalo J, Sreeram N, Qureshi SA. Transcatheter closure of acquired left ventricle to right atrium shunts. Catheter Cardiovasc Interv 2013; 82:E809-14. [PMID: 23475752 DOI: 10.1002/ccd.24917] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/03/2013] [Indexed: 11/08/2022]
Abstract
We describe transcatheter closure of an acquired Gerbode defect (left ventricle to right atrium shunt) in four patients, ranging in age from 8 to 75 years. All of them had undergone previous surgery (VSD closure in 3, aortic valve replacement in 1), and either had persistent symptoms of heart failure, or developed new symptoms several months or years later. The diagnosis was made by one of several imaging modalities (transthoracic or transesophageal echocardiography, or MRI), and confirmed at cardiac catheterization. Device closure using a variety of devices was successful in all, with resolution of symptoms. One patient developed complete heart block, requiring permanent pacemaker implantation. Transcatheter closure is effective, and may replace surgery in the management of these defects.
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Affiliation(s)
- Juha Sinisalo
- Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
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16
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Johansen M, Hoyer M, Kleiman M. Transcatheter treatment of SVC syndrome from histoplasmosis-related mediastinal fibrosis in a 9-year old male. Catheter Cardiovasc Interv 2013; 82:E708-11. [PMID: 23436729 DOI: 10.1002/ccd.24883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 02/01/2013] [Accepted: 02/17/2013] [Indexed: 11/09/2022]
Abstract
We report a case of mediastinal fibrosis secondary to histoplasmosis in a 9-year old male, who presented with superior vena cava syndrome. He was successfully treated by percutaneous superior vena cava stent placement in the outpatient cardiac catheterization laboratory.
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Affiliation(s)
- Michael Johansen
- Section of Pediatric Cardiology, Indiana University Medical Center, Indianapolis, Indiana
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Pushparajah K, Sadiq M, Brzezińska-Rajszys G, Thomson J, Rosenthal E, Qureshi SA. Endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv 2013; 82:E491-9. [PMID: 23494884 DOI: 10.1002/ccd.24735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/29/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Describe outcomes from stenting transverse aortic arch hypoplasia. BACKGROUND Hypoplasia of the transverse arch may result in residual systemic hypertension and may be amenable to stenting. METHODS Outcomes for transverse aortic arch hypoplasia stenting were collated from four centers between 2000 and 2010. Primary endpoints were reduction in peak systolic catheter gradient, dimensions of the stented segment, and systolic right arm blood pressure. Changes in antihypertensive medication and early and late complications were recorded. Data were collated for 21 patients (16 male, 5 female), median age of 16.5 years (range, 0.25-25.9 years) and median weight of 55 kg (range, 4.5-103 kg). 19/21 patients were hypertensive at baseline, excluding the two neonates after repair of interrupted aortic arch. RESULTS Median transverse arch diameter increased from 7 to 14 mm after stenting (P < 0.001). Median ratio of the transverse arch to descending aorta at the diaphragm level improved from 0.43 to 0.9 (P < 0.001). Mean gradient across the hypoplastic transverse arch was 38 mm Hg (range, 14-76) at baseline and 5 mm Hg (range, 0-13) after stenting (P < 0.001). There were no deaths and 6 early complications occurred in 5 patients. Follow-up (median 24 months) data were available for 19 patients. 17/19 hypertensive patients had follow-up data. Two neonates developed intimal hyperplasia within the stent with a stent fracture in one. Median systolic blood pressure was 153 mm Hg (range, 117-180) prestent and 130 mm Hg (range, 105-150) poststent (P = 0.0002). In 13/17 patients, the antihypertensive medication could be reduced. CONCLUSIONS Stenting of transverse aortic arch hypoplasia, although technically challenging, produced good angiographic and haemodynamic results with an early improvement in blood pressure control. These results appear to be sustained in the medium term.
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Affiliation(s)
- Kuberan Pushparajah
- Department of Congenital Cardiology, Evelina Children's Hospital, London, United Kingdom
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